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General NPI Number Information
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NPI Number | 1538353230
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Entity Type | Individual
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Provider Name | THOMAS L IRWIN JR. MSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 10/26/2010
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Provider Practice Location Address
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Address Line | 462 N TAYLOR AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63108-1831
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Country | US
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Telephone | 314-531-8879
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Fax |
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Provider Business Mailing Address
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Address Line | 12 PEACH TREE CT
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City | SAINT LOUIS
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State | MO
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Zip | 63126-3101
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Country | US
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Telephone | 314-359-1027
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW000194
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License Number State | MO
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